Here Are California's New Laws To Address The State's Opioid Crisis - capradio.org

About 2,000 Californians die from opioid overdose annually, according to the California Department of Public Health. This week in Chico, one person died and 12 were taken to the hospital after a suspected overdose on a powerful opiate called fentanyl.

The California Legislature looked at more than 20 bills last year designed to address the ongoing opioid crisis, passing 14. The laws cover a few approaches to bringing opioid death numbers down, including stemming over-prescribing practices, improving medication assisted treatment and saving people in the throes of overdose with an antidote called naloxone.

Here’s a roundup of what former Gov. Jerry Brown signed to tackle the problem.

Curbing Painkiller Prescriptions

In an effort to reduce fraud, AB 2789 will require doctors to write electronic prescriptions starting in 2022. Supporters argue this will make it easier for doctors to record prescriptions in the state’s CURES opioid database.

Expanding Treatment

Starting July 2020, AB 349 requires the Department of Health Care Services to adopt new regulations and update reimbursement rates for the Drug Medi-Cal Treatment Program

Naloxone Access

AB 2256 is designed to make it easier for pharmacists to give naloxone, an overdose antidote, to law enforcement officers who have completed special training. An individual pharmacist can already give the drug to a law enforcement officer, but wholesalers cannot. If law enforcement agencies want to acquire large amounts of naloxone, they must go through a local health department. Police departments and other agencies argue this process makes it unnecessarily difficult to get the life-saving drug. The U.S. Surgeon General said earlier this year that all people at risk for overdose, and community members who interact with them, should know how to use naloxone and keep it within reach at all times.

Patients at high-risk of overdose should have wider access to naloxone in doctor’s offices this year under AB 2760. The law requires doctors prescribing opioids to also offer patients for the overdose antidote, and educate patients and their loved ones on how to use it.

Strengthening the Opioid Database

Right now, patients can get an opioid prescription in California and then go get another in Nevada without anyone knowing they’ve double-dipped. AB 1751 authorizes the Department of Justice to share opioid prescriptions entered into California’s CURES database across state lines. The department must adopt regulations for interstate data sharing by July 2020. 

Regulating Rehab

The Department of Health Care Services will be required to adopt the American Society of Addiction Medicine treatment criteria, or a similar standard, as the minimum standard of care for licensed adult alcohol and drug abuse recovery facilities when SB 823 takes full effect in January 2023. The law’s author, Democratic Sen. Jerry Hill, said in a statement that the law will help crack down on facilities that currently use “widely divergent methods of treatment” and often lack evidence-based standards of care

Safely Storing and Dumping Drugs

As it stands, counties run their own drug take-back programs and pay to safely dispose of opioids and other prescription medications. SB 212 will now require drug-makers to take on that burden by building collection sites and paying for disposal. CalRecycle must adopt regulations to enforce the law by January 2021.

And AB 2859 could help people keep opioids away from children by requiring community pharmacies that dispense opioids to display safe storage products on the premises.

None of these laws address the growing use of Fentanyl a powerful opiod drug that is smuggled into the United States. Fentanyl is ten times as powerful as Morphine and/or Oxycodone.  It has become a preferred drug for users.  

Large quantities have been seized at ports of entry worth as much as 100 million dollars. 

Here Are California's New Laws To Address The State's Opioid Crisis - capradio.org: About two-thirds of last year’s big pile of bills designed to tackle the opioid crisis became law. Here’s what they do.

Infographic: 5 fast facts about millennial patients

Today is the first Monday of February 2019. By now I have broken all my New Year's resolutions.

How have health providers and patients coped with changes?
Health providers have struggled to keep pace with electronic health records, and new tools such as outcome studies, data analytics, and a new 'buzzword' every other week.

Welcome to the World of Work, Gen Z

Millennials probably need go no further, unless you want a wrap up of your nascent years. For the rest of us, please continue to see how different your children are from you. Most of the changes are due to the advances in technology fed by the internet, social media, and a distrust of formerly established routes of communications, purchasing, and socializing.

Gen Z has now entered the workforce.

A key feature of millennial thought process is they want in now, and perhaps yesterday. This is also true of healthcare access.

Part of Gen Z development has been a parallel process in technology, also driven by Gen Y and Gen Z, both in development and users.

Resourcefulness is at the top of the list. I’ve collected hundreds of stories from parents who have children between 11 and 17. They talk about how their children use YouTubeto figure things out themselves, without adult direction and even if they cannot read. From fixing cars to building model train sets, they know how to find the answers and directions they need.

Health providers have struggled to keep pace with electronic health records, and new tools such as outcome studies, data analytics, and a new 'buzzword' every other week.

If you are still confused there are multiple references:
The Millennials
Millenials Rising

A Taste of Generation Yum: 

How the Millennial Generation's Love for Organic Fare, Celebrity Chefs and Microbrews Will Make or Break the Future of Food

The Revolution Generation: How Millennials Can Save America and the World (Before It's Too Late)

The Millennial Narrative: Sharing a Good Life with the Next Generation

Where the Millennials Will Take Us: A New Generation Wrestles with the Gender Structure

Zero Hour for Gen X: How the Last Adult Generation Can Save America from Millennials

Beyond Age Rage: How the Boomers and Seniors Are Solving the War of the Generations 

Infographic: 5 fast facts about millennial patients | Physicians Practice: Having trouble viewing? Click to download

How your health information is sold and turned into ‘risk scores’ - POLITICO

THE HORSE IS OUT OF THE BARN

Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores.

While the data collection is aimed at helping doctors make more informed decisions on prescribing opioids, it could also lead to blacklisting of some patients and keep them from getting the drugs they need, according to patient advocates. Health insurance giant Cigna and UnitedHealth's Optum are also using risk scores.

There’s no guarantee of the accuracy of the algorithms and “really no protection” against their use, said Sharona Hoffman, a professor of bioethics at Case Western Reserve University. Overestimating risk might lead health systems to focus their energy on the wrong patients; a low risk score might cause a patient to fall through the cracks.

No law prohibits collecting such data or using it in the exam room. Congress hasn’t taken up the issue of intrusive big data collection in health care. It’s an area where technology is moving too fast for government and society to keep up.

“Consumers, clinicians and institutions need to understand that personalized health is a type of surveillance,” says Harvard University professor Eric Perakslis. “There is no way around it, so it needs to be recognized and understood.”

The justification for risk scoring is the terrible opioid epidemic, which kills about 130 Americans a day and is partly fueled by the overprescribing of legal painkillers. The Trump administration and Congress have focused billions on fighting the epidemic, and haven’t shied from intrusive methods to combat it. In its national strategy, released Thursday, the White House Office of National Drug Control Policy urged requiring doctors to look up each patient in a prescription drug database.

Health care providers legitimately want to know whether a patient in pain can take opioids safely, in what doses, and for how long — and which patients are at high risk of addiction or overdose. Data firms are pitching their predictive formulas, or algorithms, as tools that can help make the right decisions.

The practice scares some health care safety advocates. While the scoring is aimed at helping doctors figure out whether to prescribe opioids to their patients, it might pigeonhole people without their knowledge and give doctors an excuse to keep them from “getting the drugs they need,” says a critic, Lorraine Possanza of the ECRI Institute.

The algorithms assign each patient a number on a scale from zero to 1, showing their risk of addiction if prescribed opioids. The risk predictions sometimes go directly into patients’ health records, where clinicians may use them, for example, to turn down or limit a patient’s request for a painkiller.

Doctors can share the patients’ scores with them — if they want to, the data mongers say. “We stop really short of trying to advocate a particular opinion,” said Brian Studebaker from one of the risk scoring companies, the actuarial firm Milliman.

According to addiction experts, however, predicting who’s at risk is an inexact science. Past substance abuse is about the only clear red flag when a doctor is considering prescribing opioid painkillers.

But several companies POLITICO spoke with already are selling the predictive technology. None would name customers. Nor would they disclose exactly what goes into the mathematical formulas they use to create their risk scores — because that information is the “secret sauce” they’re selling.

Congress has shown some interest in data privacy; a series of hearings last year looked into thefts of data or suspect data sharing processes by big companies like Facebook. But it hasn’t really delved into the myriad health care and health privacy implications of data crunching.

Consumers have a “basic expectation” that the data they provide to websites and apps “won’t be used against them,” said Sen. Brian Schatz (D-Hawaii), who co-sponsored legislation last year barring companies from using individuals’ data in harmful ways. The HIPAA privacy law of the late 1990s restricted how doctors share patient information, and Schatz says “online companies should be required to do the same.”

A bill from Sen. Ed Markey (D-Mass.), S. 1815 (115), would require data brokers to be more transparent about what they collect, but neither his bill nor Schatz’s specifically address data in health care, a field in which separating the harmful from the benign may prove especially delicate.

How your health information is sold and turned into ‘risk scores’ - POLITICO: Information used to gauge opioid overdose risk is unregulated and used without patient consent. 

HIPAA regulations appear to prohibit personal information from release to the public, so 'bare statistics' are only available, unassigned to a particular patient. It is unknown at this time what PHI is transmitted to a provider.. 

Companies are starting to sell “risk scores” to doctors, insurers and hospitals to identify patients at risk of opioid addiction or overdose, without patient consent and with little regulation of the kinds of personal information used to create the scores. Over the past year, powerful companies such as LexisNexis have begun hoovering up the data from insurance claims, digital health records, housing records, and even information about a patient’s friends, family and roommates, without telling the patient they are accessing the information, and creating risk scores for health care providers and insurers.  

Direct Primary Care as an alternative Payment Plan

Our health system has grown into a size that is no longer self supporting. Most of our care is in an outpatient setting which should be very inexpensive The chart below displays the huge diifferences in cost.  Just by eliminating the administrative positions in an office decreases overhead by 50% or more

Paul Thomas MD, physician-owner of Plum Health, a DPC practice in inner-city Detroit understands the needs of economically disadvantaged patients. “I intentionally selected a health professional shortage area as a place to start and grow my medical practice,” he says. “I believe that the DPC model gets us closer to the goal of truly affordable health care for our patients and communities.”

But DPC practices don’t just serve patients in inner-cities and suburbia. Donna Givens, MD, is the physician-owner of Grant’s Pass Family Medicine in rural Oregon. “Most of my patients are in the gap between qualifying for Medicaid and being able to afford insurance,” she says.

DPC practices can also provide a safety net for minority patients. Belen Amat, MD, the owner of Direct Primary Care of West Michigan, estimates that 70 percent of her patients are primarily Spanish-speaking.

Across this country, DPC practices are filling an important niche by providing care for underserved patients. But rather than indenturing themselves to a government or corporate entity, physician-owners of DPC practices are providing care on their own terms, without bureaucratic headaches and red-tape frustrations.

Direct care cuts out third-party payers like Medicare, Medicaid, and insurance companies. Instead, patients pay the doctor directly, usually through a monthly fee, which averages $77 for DPC practices.

Because direct care doctors are not beholden to the insurance company, they spend less time on unnecessary documentation and more time on patients. And because doctors don’t have to spend a fortune trying to get paid by an insurer, they can often keep their overhead remarkably low, passing savings along to patients.

It is easy to criticize a new model if you don’t really understand what DPC doctors do. The Journal of the American Medical Association (JAMA) argued that DPC is structurally flawed, in that it incentivizes physicians to accept healthier patients.

But this argument does not match with the reality that many DPC practices experience. In my practice, most patients have multiple chronic illnesses — the very reason they see the benefit in paying a monthly membership for care. New patients have sometimes been without health care and off medicines for months to years, and require frequent visits to get stabilized.

And many times, rather than being “cherry-picked,” patients come to DPC practices because they have been dismissed from conventional practices. For example, Tiffany Blythe, DO, the owner of Blue Lotus Family Medicine in Kansas City, will accept unvaccinated children who are often unwelcomed into other doctors’ offices. “I’ve found that many anti-vax parents really are trying to do the best they can for their child. They just need education, patience, and support to find their way.” And with the additional time that DPC offers, Blythe has been able to convince some parents to vaccinate their children ultimately. “It takes time to overcome fear with facts,” she notes.

In my practice, I have several patients who were dismissed from their regular doctors. One 80-year-old Medicare patient came to me tearfully with a dismissal letter from her previous doctor in hand. She was “fired” from the practice, she said because she refused to talk to a chronic care coordinator. “I was just tired of them bugging me all the time,” she told me. “They kept calling me, and a nurse would come to my house and tell me the same things my doctor did.”

If you talk to DPC doctors, you will hear many stories like these. Inspirational stories not only of patients accessing affordable, quality health care but also of physicians who are happy to practice medicine again.

DPC offers an alternative practice model for doctors to regain the joy in practicing medicine. When medical students and residents hear DPC doctors talk, they get inspired to practice primary care. And studies are clear: more primary care docs equal better health care across populations.

Affordable care, better patient experiences, better patient outcomes, and physician well-being: the quadruple aim. And this is exactly what direct primary care provides.

PLUM HEALTH BENEFITS

• A direct relationship with your doctor
• Fewer patients = more time with your doctor
• Your health and wellness are the priority
• Call us at any time, email us, or text us
• Save hundreds on labs, imaging, and prescription meds
• Clear and consistent pricing
• Peace of mind

Learn More →

  Direct Payment

Insurance Plan

     The difference in cost is huge. These differences only apply to outpatient vs Hospital Cost.  Hospital charges are difficult to analyze and are maximized because of the manner in which insurance companies reimburse them.                                                                                                                                                                                                                                                                                                

CONVENTIONAL HEALTHCARE

• Rushed appointments
• Doctor's have thousands of patients = less time
• Sometimes you'll have to see a mid-level provider
• Only available during business hours, typically 9 - 5
• 2-10x markup on labs and services
• Services billed at the highest rate possible in order to maximize reimbursement from your insurance company

Learn More →

Pamela Wibble, MD started the Ideal Medical Clinic in Oregon some years ago before anyone knew what Direct Primary Model even existed. Dr Wibble created this practice model because of her own personal experiences with physician suicide. Many physicians 'burn out' because of the moral conflict between the Hippocratic Oath and the necessity of economic realism.

There is No "Routine Procedure"

"Mrs Smith, this is a routine procedure, don't be nervous" How many times have I heard a nurse, or physician tell this to a patient in order to assuage their anxiety. Perhaps we as physicians are saying that to minimize our own anxiety when in fact we all know of the horrendous things that can go wrong during a 'routine procedure' ?

 Martha Wright had her first colonoscopy at Missouri’s Cass Regional Medical Center. She died the next day of internal bleeding, an unusual outcome that has the hospital under extra scrutiny from regulators.

Her Attorney wants accountability

At 83, Martha Wright had never had a colonoscopy, even though government guidelines call for nearly everyone to be screened for colon cancer after age 50.

The Pleasant Hill resident was scared of the test, her daughter Dena Royal said, because she was petite — less than 5 feet tall.

“What she repeatedly said was, ‘I don’t want to have a colonoscopy; it will kill me,” said Royal, a former Kansas City paramedic and respiratory therapist. “We just kind of said, ‘Oh mom, it’s routine, it’s no big deal.’”

Wright had her first colonoscopy Aug. 2 at Cass Regional Medical Center, after a doctor recommended it because she was anemic.

She died the next day of internal bleeding.

Martha Wright celebrated her 80th birthday three years ago in Kansas City.

SUBMITTED PHOTO

It was a highly unusual outcome from a very common procedure that now has the Harrisonville hospital under extra scrutiny from government regulators.

State inspectors came out to investigate Wright’s death in late November after Royal filed a complaint. They found that Wright showed several signs of distress after the procedure, but Cass Regional staff didn’t properly respond. They also said 348 more colonoscopies had been performed there since Wright’s death, without addressing the deficiencies in care.

The inspectors passed their findings to the federal Centers for Medicare and Medicaid, which classified the situation as an “immediate jeopardy” that "placed all patients at the facility at risk.” It’s one of the agency’s most serious designations. If the situation is not promptly addressed, hospitals can lose their ability to bill Medicare.

THE TEST

In a colonoscopy, patients are under general anesthesia while a doctor inserts a small flexible tube with a tiny camera through the patient’s rectum and into the large intestine. It’s a key tool for detecting colorectal cancers, but according to the Centers for Disease Control, about one-third of Americans who should be getting the test aren’t.

Still, it’s one of the most common medical procedures in the United States and it’s usually safe. Serious complications occur in only about 1.6 percent of patients, though experts say that’s still too high, given that millions of colonoscopies are done each year.

Deaths are even more rare.

In one of the largest studies done on the topic, researchers examined 16,318 colonoscopies performed in Kaiser Permanente hospitals between 1994 and 2002. They found only one death they could attribute to the procedure — a rate of 0.006 percent. A 2008 study on Canadian colonoscopy patients came up with a similar number. 

By contrast, the five-year death rate for people with localized colorectal cancer is about 10 percent, and it spikes to almost 30 percent once the cancer spreads to surrounding tissues or organs.

According to the inspection report and medical records provided by Royal, Wright’s colonoscopy was, at least at first, the type everyone wants to get.

There was no sign of colon cancer. There were no polyps to be removed. It was a “clean” test that was “completed without difficulty or complications,” according to medical records reviewed by the inspectors.

Wright was sedated for the procedure, and because she didn’t have anyone to drive her home and watch her for 24 hours, she had to stay at the hospital overnight per Cass Regional policies.

The test was in the morning. By 5 p.m. she was complaining of pain in her left upper abdomen, but said it was tolerable: a 3 on a scale of 1 to 10. By 10:15 p.m. the pain had increased to 7 out of 10 and had spread to her left shoulder. According to medical records, a nurse told her she probably had gas and gave her Tylenol.

The inspection report said this is when nursing staff should have contacted the surgeon to inform him or her of the change in Wright’s condition.

Instead, the doctor wasn’t notified until about 2:30 a.m., when Wright awoke complaining of nausea, clammy skin and shortness of breath, in addition to the abdominal pain. The doctor ordered some tests, including a CT scan, but Wright kept getting sicker.

She was taken to the intensive care unit at 4:50 a.m., but by then she was unresponsive, with no breathing and no pulse. Hospital staff tried CPR, but at 5:14 a.m. Wright was declared dead.

The radiologist who read the CT scan found a “large amount of hemorrhage ... within the abdomen and pelvis,” which the emergency room physician listed as her official cause of death .

“She basically bled to death,” said Aaron Woods, the Lee’s Summit attorney Royal hired.

Royal said she knew something must be wrong when the phone rang early in the morning. But it was still a “gut-wrenching” shock to hear that her mother was dead.

“I mean, my mom was 83 but I thought she still had a lot of life left,” Royal said. “This was just so unexpected.” 

It wasn’t the incident itself that drew the most concern from government officials, though. Medical mistakes happen. Cass Regional rate of re-admitting patients after a colonoscopy is 15.5 per 1,000. That is actually slightly better than the national average (16.4 per 1,000 patients), according to federal data.

What was most concerning to regulators was the hospital’s response. They said Cass Regional officials should have recognized Wright’s death as a “sentinel event” that signaled potentially broader problems, immediately investigated to find out how it happened and then educated staff about how to keep it from happening again.

Instead it was more than a month before the internal investigation started, and “the facility also failed to educate nursing staff in a timely manner,” the federal report said. When staff were eventually trained more on assessing patients’ conditions, it “was informal and without documentation of who attended.”

Cass Regional correction plan includes many policy changes to keep that from happening in the future.

Upon reviewing the case it was apparent that staff failed to notify the surgeon of a change in her postoperative condition shortly after discharge in a timely manner.

Addendum

Several things readers should note:

1. There is no such thing as a routine procedure. Routine only means they do a lot of the procedure. If there is a problem the surgeon will make a note of it. If there is an abnormal postoperative course nurses must notify the responsible surgeon. The surgeon is responsible for making a decision, not the nurse

Familiarize yourself by watching the following videos.*******

Getting Ready for your Colonoscopy

Some things to think about

Colonoscopy woman bled to death. Hospital investigated | The Kansas City Star:

Virginia law aims to save people thousands in cost for emergency medical attention |

Rooftop landing pad for Riverside Community Hospital

Or

Surface travel by EMS

A horseback ride accident leads to thousands in air ambulance medical cost Sonna Anderson was enjoying a horseback ride through the Badlands in North Dakota in September 2017 when her horse, Cody, got spooked, jerked toward a fence and tripped on a cow track in the dirt. The horse rolled onto Anderson, who hit her head, briefly lost consciousness and broke three ribs. The 911 transcript shows that an ambulance reached the 60-year-old judge from Bismarck within 20 minutes. Anderson was secured on a backboard and ready to go when an air ambulance, a helicopter with a medical crew, also landed at the scene. Anderson says her husband asked repeatedly whether the ground ambulance crew could take her by ground; there was a hospital less than an hour’s drive away
“But he was told that [the air ambulance] was necessary. They never told him why it was necessary or how much it cost, but they insisted I had to go by air ambulance,” Anderson said. “But it’s so odd there is nothing in the record that indicated it was time-sensitive or that I needed to be airlifted.”
For that one helicopter ride, to a hospital farther away in Bismarck, records show that Valley Med Flight charged Anderson $54,727.26. Sanford Health Plan, her insurance, paid $13,697.73. That left Anderson with a $41,029.53 bill.

Rural Hospitals Closing

There are large areas of rural America that have become health care deserts. In an effort to contain rising health care costs, CMS has made it economically unobtainable to provide adequate hospitals in rural areas. A number of alternatives are in use, telehealth, remote monitoring, access to lower level providers such as physician assistants and nurse practitioners

Virginia law aims to save people thousands in cost for emergency medical attention | WTKR.com:

These Patients Had Sickle-Cell Disease. Experimental Therapies Might Have Cured Them. - The New York Times

A slide of blood showing abnormal red blood cells (sickle cells). Note the bizarre shapes. Normal red blood cells are round or spherical.  This is caused by abnormal hemoglobin which interferes with the transportation of oxygen to the cells of the body.

Success against sickle-cell would be “the first genetic cure of a common genetic disease” and could free tens of thousands of Americans from agonizing pain.  

Employment can be difficult because the disease is debilitating. Yet many who apply for Social Security disability are denied, Dr. Tisdale said. They end up at emergency rooms when they are in crisis.

And treating the disease, with its complications, is expensive: annual costs per patient are estimated at $10,000 a year for children and $30,000 for adults. Those with the disorder go in and out of hospitals.

Tantalizing science

Doctors and Hospitals Say E-Record Goals Are Unrealistic - The New York Times

This article dates back to the dawn of electronic health records in 2009.  Not much new today, 9 years later. Most medical practices utilize electronic health records despite being unrealistic, inefficient, and reducing physician time with patients.  Most doctors spend their time gazing at a computer screen rather than engaging with their patient face to face.



The feds accomplished their goal. to set up a system whereby they could extract data to analyze.  I have yet to see any studies regarding the use of Electronic Health Records vs ballpoint technology in regard to changes in quality improvement.



The shape of this article give one little hope for following any recommendations by the federal government.  One thing is for certain, those physicians who advised our system were either ignored or they gave bad advice.

WASHINGTON — In February 2009, as part of legislation to revive the economy, Congress provided tens of billions of dollars to help doctors and hospitals buy equipment to computerize patients’ medical records.

But the eligibility criteria proposed by the Obama administration are so strict and so ambitious that hardly any doctors or hospitals can meet them, not even the most technologically advanced providers like Kaiser Permanente and Intermountain Healthcare.

Doctors and hospital executives, who have expressed their frustration in meetings with White House and Medicare officials, said the issue offered a cautionary tale of what could happen when good intentions meet the reality of America’s fragmented health care system.

The goal of the law is to provide financial incentives, through Medicare and Medicaid, to encourage doctors and hospitals to adopt and use electronic health records. When the bill was passed, the Congressional Budget Officeestimated that the incentive payments would total $34 billion.

It is no surprise that tiny hospitals in the Midwest and doctors practicing by themselves would grumble about the White House proposals.

Continue reading the main story

But elite institutions have similar concerns. Among those expressing deep reservations about the proposals are pioneers in the use of health information technology like Kaiser, Intermountain, the Mayo Clinic and Partners HealthCare System in Boston, which includes Brigham and Women’s Hospital and Massachusetts General Hospital.

One of most revealing assessments came from Dr. Thomas H. Lee, president of the physician network at Partners HealthCare.

“Effective use of electronic health records will greatly improve patient safety, quality and efficiency,” Dr. Lee said in a letter to Medicare officials. But he said the approach taken by the administration was based on “unrealistic expectations” and “unachievable timelines.”

“We are very concerned about the requirement that hospitals and eligible professionals must meet each and every one of the objectives to demonstrate meaningful use and thereby qualify for incentive payments,” Dr. Lee said.

In meetings at the White House, doctors and hospital executives have conveyed the same message: the president’s all-or-nothing approach could discourage efforts to adopt electronic health records because some of the proposed standards are impossibly high and the risk of failure is great. They pleaded with the administration to take a more gradual approach and reward incremental progress.

At least 27 senators and 245 House members echoed those concerns in letters to the administration.

Administration officials said they took the concerns seriously, but refused to say whether they would relax the proposed requirements.

“We want to strike a balance,” said Jonathan D. Blum, deputy administrator of the Centers for Medicare and Medicaid Services. “We will provide flexibility for doctors and hospitals, but push them to elevate their performance. Final rules will be out in early summer.”

Anthony A. Barrueta, the vice president for government relations at Kaiser Permanente, said his company, the nation’s largest nonprofit health plan, had years of experience with electronic health records, but could not meet all the criteria for incentive payments.

Dr. Brent E. Wallace, chief medical officer at Intermountain Healthcare, in Utah, said the administration’s criteria were “too rigid, requiring too much change in too short a time.”

Doctors and Hospitals Say E-Record Goals Are Unrealistic - The New York Times: Critics say the Obama administration’s criteria for computerizing medical records are too strict and ambitious.

Transparent Hospital Pricing Exposes Wild Fluctuation, Even Within Miles | California Healthline

The federal government’s new rule requiring hospitals to post prices for their services is intended to allow patients to shop around and compare prices, a step toward price transparency that California has mandated since 2005.

California Healthline examined the price lists — known in hospital lingo as “chargemasters” — of four large acute care hospitals in Oakland, Calif., and another four in Los Angeles, using the documents California hospitals have been reporting annually to the California Department of Public Health — the same information the federal government is now requiring all hospitals to post on their websites.

The comparison of some basic procedures found wide-ranging prices, sometimes between hospitals that are part of the same network or located just miles from each other. For instance, the list price on a liter of basic saline solution for intravenous use ranged from $56 to $383, nearly seven times as much. A brain MRI with contrast was priced from $3,200 to $8,800 at the hospitals.

While more information is always welcome, the new data will fall short of providing most consumers with usable insight.

That’s because the price lists displayed this week, called chargemasters, are massive compendiums of the prices set by each hospital for every service or drug a patient might encounter. To figure out what, for example, a trip to the emergency room might cost, a patient would have to locate and piece together the price for each component of their visit — the particular blood tests, the particular medicines dispensed, the facility fee and the physician’s charge, and more.

“I don’t think it’s very helpful,” said Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. “There are about 30,000 different items on a chargemaster file. As a patient, you don’t know which ones you will use.”

And there’s this: Other than the uninsured and people who are out-of-network, few actually pay full charges.Whether you will be able to determine the best prices when you have a need for a hospital is another question. KHN senior correspondent Julie Appleby and California Healthline’s Barbara Feder Ostrov recently wrote about this new rule and found price lists befuddling to most anyone without an advanced medical degree.

Harriet Blair Rowan: hrowan@kff.org, @HattieRowan

Transparent Hospital Pricing Exposes Wild Fluctuation, Even Within Miles | California Healthline: A new federal rule requires hospitals to post their prices online. These lists reveal the wildly different charges for basic procedures and services, but consumers will have a hard time putting this information to use.